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Background:The transversus abdominis plane block (TAP block) can give a good analgesia after lower abdominal surgery. The administered local anesthetics determine the TAP block duration, so administration of adjuvants can be utilized to extend local anesthesia time and increase efficiency. Aim of the work:To assess the efficacy of TAP block with dexamethasone on pain relief after lower abdominal gynecological procedures. Patients and methods: A randomized controlled study was performed on 100 women, aged 25-56 years, ASA I&II. Listed for lower abdominal gynecological procedures under general anesthesia, TAP block was performed bilaterally at the end of surgery. Patients were randomly divided into two groups: Group I (n=50) bilaterally received 15ml of 0.2% levobupivacaine plus 1.5 ml normal saline. Group II (n=50) bilaterally received 15 ml of 0.2% levobupivacaine plus1.5 ml) 6 mg (Dexamethasone. The primary outcome was visual analogue score (VAS) to assess postoperative pain. The secondary outcomes were the time to first analgesic request, number of patients needed meperidine, overall dose of analgesic consumption/24h and complications. Results: VAS was significantly lower for 12h at rest and for 10h on activity in group II compared to group I (P<0.001), prolonged time to first analgesic request (P <0.001) and less meperidine requirement in group II (P <0.001). Conclusion:Combination of dexamethasone to levobupivacaine in TAP block was effective in decreasing the severity of postoperative pain, overall meperidine consumption and prolonging the time to first analgesic request after lower abdominal gynecological procedures.

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